Office of the Independent Inspector General

Cook County - OIIG Complaint Form

You may report wrongful acts, infractions, or omissions on the part of any County agency or employee, including those of Elected or Appointed Officials and their employees.

PLEASE PROVIDE AS MANY DETAILS AS POSSIBLE IN THE FOLLOWING COMPLAINT!
BE SURE TO INCLUDE NAMES OF ACCUSED PERSONS AND WITNESSES, DATES OF EVENTS, AND SPECIFIC INFORMATION THAT THOROUGHLY EXPLAINS YOUR ALLEGATION(S).
FAILURE TO DO SO MAY PREVENT AN INVESTIGATION OF YOUR COMPLAINT.
WE APPRECIATE YOUR COOPERATION.

Also, please mail any documentation that may support your complaint to:

Office of the Independent Inspector General
Cook County - Complaint Hotline
69 West Washington St., Suite 1160
Chicago, Illinois 60602

Contact Information

(optional)

Last Name:

First Name:

Date of Birth:

(mm/dd/yyyy)

Home Address:

City:

State:

Zip Code:

(5 digits only)

Home Telephone:

(e.g. 312-111-2222)

Work Telephone:

(e.g. 312-111-2222)

Email Address:

Would you like to be contacted at another location?

(optional)

Address:

City:

State:

Zip Code:

(5 digits only)

Telephone:

(e.g. 312-111-2222)

Name of person(s) and agency involved in wrongful act

(optional)

Last Name:

First Name:

Position/Title:

Agency:

Location of Incident:

City:

State:

Zip Code:

(5 digits only)

Please add more names if neccessary

Last Name:

First Name:

Position/Title:

Agency:

Location of Incident:

City:

State:

Zip Code:

(5 digits only)

Last Name:

First Name:

Position/Title:

Agency:

Location of Incident:

City:

State:

Zip Code:

(5 digits only)

Wrongful Act Description

(required)

Which of the below items best describes the act upon which your complaint is based?

		Reporting to work under the influence of any substance that would adversely affect safety or job performance
		Selling or possessing controlled substances on County Property
		Fighting or disruptive behavior
		Patient, employee, or visitor abuse or harassment
		Unauthorized possession of weapons
		Willful destruction of property
		Gross insubordination
		Employee theft or unauthorized possession of County property
		Negligence
		Misuse of Timekeeping Records/Falsification
		Absence for 3 cons. days w/o notification
		Class A misdemeanor or felony conviction(s)
		Violation of a County Ordinance/Executive Order
		Falsification of employment or other County record
		Lack of proper license(s) or certifications
		Failure to report arrest to Dept. Head
		Misuse of confidential or proprietary info
		Failure to follow County policies, procedures, or practices
		Engage in non-County business w/o authorization
		Excessive Tardiness or Absenteeism

		Leaving assigned work area w/o prior authorization
		Loitering on premises without authorization
		Litter or create unsanitary conditions
		Smoke in prohibited area(s)
		Engage in gambling on premises
		Intimidate or coerce employees or citizens through threats
		Sleeping or inattention to duty
		Perform less than satisfactorily
		Create an unsafe condition or fail to abide by safety policies
		Use any County instrumentality for unauthorized purpose
		Dual Employment
		Unlawful political discrimination
		Violation of a local, state, or federal law(s)
		Official misconduct
		Contractor fraud
		Breach of contract
		Contractor waste
		Contract oversight
		Discrimination, Discriminatory Harassment, Sexual Harassment and Retaliation
		Other

Please describe the wrongful act you witnessed

(min. 20 chars)

Additional Information

(optional)

Has this complaint been filed with any other agency or law enforcement entity?

Don't know

Yes

Agency Name:

Date Filed:

(mm/dd/yyyy)

Have you or anyone filed any litigation against this agency/individual?

Don't know

Yes

Court Name:

Case No.:

(max. 20 chars)

Current status of the Court Action:

Are there any documents regarding the wrongful act or omission?
(i.e. contracts, memos, letters, evaluation forms, minutes of meetings, etc.)

Don't know

Yes

Please describe documents:

Are you aware of the existance and location of any other relevant evidence?
(i.e. photographs, receipts, personal or real property)

Don't know

Yes

Please identify documents:

Additional Comments

Please provide us with any additional comments/notes/description regarding the wrongful act:

Provide the name(s) of other people we may contact with knowledge of the wrongful act or omission. Include the address and phone number of such person(s)

(optional)

Last Name:

First Name:

Telephone:

(e.g. 312-111-2222)

Address:

City:

State:

Zip Code:

(5 digits only)

Please add more names if neccessary

Last Name:

First Name:

Telephone:

(e.g. 312-111-2222)

Address:

City:

State:

Zip Code:

(5 digits only)

Last Name:

First Name:

Telephone:

(e.g. 312-111-2222)

Address:

City:

State:

Zip Code:

(5 digits only)

Confirmation

(required)

I fully acknowledge that the information contained in this complaint is true and accurate to the best of my ability and belief.

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phone: 312.603.0350
118 N. Clark St., Suite 1160, Chicago, Illinois 60602